Benjamin Rush

“Be indulgent to the poor.” Those were the last words of Benjamin Rush, spoken to his son. An appropriate coda for a man who may have had the deepest altruistic streak of any of our nation’s founders.

“More benevolent, more learned, of finer genius…more honest.” That was Thomas Jefferson’s comparison of Rush to other signers of the Declaration of Independence. Jefferson’s political rival John Adams was equally admiring: “He has done more good in this world than Franklin or Washington.”

One of Rush’s many small philanthropic acts was to catalyze a late-in-life reconciliation between Adams and Jefferson, whom he called “the North and South Poles of the American Revolution.” Rush cajoled the two old lions, who had been close collaborators before they became bitter rivals, into resuming a correspondence. As a result, when they died within hours of each other on July 4, 1826—the 50th anniversary of the Declaration—they were once again good friends.

The only physician to take a prominent role in the establishment of our nation, it was Rush who pressed Thomas Paine to write Common Sense, gave the book its title, and shaped the drafts as Paine read them aloud. The political doctor hosted George Washington for dinners, and helped get the Virginian selected to head the Continental Army. Ben Franklin treated the animated conversationalist and fellow Pennsylvanian like a son, sponsoring bits of his scientific education while Rush was a star medical student in Scotland, and introducing him to some of Europe’s leading thinkers.

Rush was a fascinating combination of soft and hard, of humanitarianism and patriotism. He revered his first ancestor who had relocated to America—his great-great-grandfather John, a commander of horse troops in Cromwell’s army who in his 60s refused to conform to the Church of England. “He fought for liberty, and migrated into a remote wilderness in the evening of his life in order to enjoy the privilege of worshipping God according to the dictates of his own conscience,” wrote Rush. The kind doctor hung over his bed a sword he had inherited from John, describing it to his wife as “dyed…with the blood of the minions of arbitrary power.”

Rush’s grandfather and father were similar mixes of vinegar and honey, both being known equally as ingenious gunsmiths and as intensely religious Presbyterians. Benjamin’s own service during the Revolutionary War was dualistic. After Britain cut off gunpowder imports to the recalcitrant colonies, he (then a professor of chemistry) devised the formulas for substitute homemade explosives. Meanwhile, as an army surgeon he dispensed mercy on battlefields to friend and foe alike.

In debates leading up to the rupture with Britain, Rush was a fire-breather. While attending an oration in London where one speaker dismissed American demands by noting they possessed no cannonballs, Rush leapt to his feet and shouted that his countrymen would remedy the deficiency “by digging up the skulls of those ancestors who had courted expatriation from the old hemisphere under the vivid hope of enjoying more ample freedom in the new one!” In the Continental Congress, Rush was a stubborn advocate for full self-governance, arguing that war and even deadly defeat would be preferable to loss of liberty. He later recollected the “pensive and awful silence that pervaded the house” as the Declaration of Independence was signed, since the signatories knew it might “be our own death warrant.”

Among his fellow seekers of freedom, though, Rush was a force for cooperation and comity. As the former colonies struggled to unify in the Articles of Confederation, he told other delegates that “when I entered that door, I considered myself a citizen of America.” While later helping put the U.S. Constitution in place to end the wrangling and drift of the early republic, he commented approvingly that “while the nations of Europe have waded into order through seas of blood, you see we have traveled peaceably into order only through seas of blunders.”

Rush’s vision for his nation was that it must be a moral society, not just a political power. During his schooling in Edinburgh he was impressed by the way his host city mixed Enlightenment wisdom with Presbyterian ethics. “The churches were filled on Sundays…. Swearing was rarely heard…drunkenness was rarely seen…. Instances of fraud were scarcely known…. I once saw the following advertisement pasted up at the door of the play house: ‘The gentleman who gave the orange-selling woman a guinea instead of a penny last night is requested to call at the check office for it.’” He was less impressed with London, “of alehouses and taverns and gin swigging, of elegant lords and their ladies and liveried footmen, of dim street lights and vice and cruelty and grime and public hangings.”

After completing the best-available medical training abroad, Rush immediately began to apply his knowledge to improving and softening life for his fellow Americans. When he returned to Philadelphia and became the first professor of chemistry in America at the age of 23, he simultaneously opened a private medical practice ministering almost exclusively to the poor. Rush had “a natural sympathy with distress of every kind,” and afflicted health was a heartbreak he knew well. Three of his siblings died as youths, and he and his wife themselves lost four children in infancy, and others to adult afflictions. Diseases like yellow fever, diphtheria, typhus, and tuberculosis descended with grim regularity in his day, sometimes almost depopulating entire villages and neighborhoods.

In 1786, Rush provided expertise and resources, and raised additional money from others, to open the Philadelphia Dispensary—the first free walk-in health clinic in the United States. House calls for indigents too sick to leave home were also provided. Rush was famous for his inquisitive and kindly bedside manner, which he offered to citizens modest and mighty without distinction. An on-site apothecary compounded medicines of all sorts, which were given away at no charge along with the advice of the attending physicians. Rush did all of his work at the Dispensary for free, even though the thousands of patients he ministered to there required him to reduce his private practice by a fourth. (The charity treated 8,000 patients in just its first five years.) With Rush’s encouragement, the model of the Philadelphia Dispensary subsequently spread to other cities, and this kind of clinic became for generations our primary means of providing health care to the urban poor.

Rush also practiced medicine at the Pennsylvania Hospital, which had been established with a large personal donation from Benjamin Franklin and then sustained by him and other donors as the first U.S. institution of its kind, devoted to restoring sick residents to active life, regardless of their means. When Rush joined the charity he put a particular emphasis on “care of lunatics.” Recognizing that most mental disorders were organic illnesses, he created a new ethic of respect and tenderness for sufferers who had mostly just been locked away before. He separated the insane from criminals, improved their housing and caretaking, and set them to productive work. Out of this experience, Rush wrote one of the first books on mental illness, which became influential internationally and caused him to be known as “the father of American psychiatry.”

Rush also offered extraordinarily popular medical lectures at the University of Pennsylvania. He is estimated to have taught 3,000 medical students, and thereby spread updated understandings of the healing arts all across the U.S. Historians note that nearly every prominent physician in America during our first hundred years was trained either by Rush or by one of his pupils.

Physicians in that era, including Rush, had few effective tools, and sometimes harmed as much as they helped, via their bleedings and dosings and primitive understandings of biological processes. But Rush was better than most—a pioneer at introducing scientific method into health care, he improved our knowledge of many diseases, and showed strong instincts for cause and effect. He was particularly helpful in advancing preventative medicine and public-health practices. “Obviating diseases is the business of physic as well as curing them,” he wrote. In his day, the poor seldom washed, and the wealthier generally did so only in warmer weather. Street gutters served as open sewers, and lice, flies, and mosquitoes were everywhere. He knew these problems well from his many house calls on sick patients in Philadelphia’s most wretched neighborhoods.

To improve conditions, Dr. Rush held classes for women on the importance of keeping houses clean, cool, and insect-free. He encouraged the use of soap, wearing fresh clothing, and eating healthy food. He circulated one of the first pamphlets encouraging daily exercise as an essential contributor to health. He and a few friends formed a Society for Inoculating the Poor which provided immunizations without charge. And Rush recognized that tooth decay can cause other infections and problems.

He was a very early and persistent campaigner for temperance, warning that hard liquor had many pernicious effects on the human body and on social life, a position he got endorsed by the College of Physicians in Philadelphia. He promoted “simple, healthy, and frugal drinks” as alternatives to alcohol. Our first practical temperance societies grew out of his work.

He did merciful duty in military medicine. In most wars, he noted, “a greater proportion of men perish with sickness…than fall by the sword.” So he urged military leaders to pay attention to camp locations and sanitation, along with the diet, cleanliness, and dress of their soldiers. “If it be criminal in an officer to sacrifice the lives of thousands by his temerity in a battle, why should it be thought less so to sacrifice twice their number in a hospital by his negligence?” The Continental Army sponsored pamphlets to bring Rush’s advice out to fighters in the field.

In addition to the humane ideas, abundant pro bono work, and personal donations that he brought to medicine, Benjamin Rush was a pioneering philanthropist in many other fields. He organized and became president of the first anti-slavery society in America. His heavily circulated Address…Upon Slave-keeping urged in 1773 that the traffic in persons be shut off, and that until such time as all slaves were set at liberty and given the same “privileges of freeborn British subjects” they should “be educated in the principles of virtue and religion…taught to read and write…and instructed in some business, whereby they may be able to maintain themselves.” Rush poured his own money and energy into raising up the most prominent black Christian fellowship in America, the African Methodist Episcopal Church.

Dr. Rush was also famous for his prison philanthropy. Instead of public punishments, he called for placing criminals in private confinement in hygienic facilities, with labor, solitude, religious instruction, and correction as necessary. His paper “An Enquiry into the Effects of Public Punishment upon Criminals, and upon Society” earned him another accolade of intellectual parentage—the “father of penal reform.”

As an education philanthropist, Rush organized and raised the funds to create Dickinson College, bringing “the light of science and religion” to students in backwoods Pennsylvania who were poor and of dissenting faiths. He led a similar effort to set up Franklin College (now Franklin & Marshall) so that German youths living distant from the capital could likewise have access to education. Germans made up about a third of his state’s population, he noted, and “fill the treasury with their taxes” while “their blood was shed liberally” in the war for independence, yet few from those families headed into “the learned professions, or possess office.”

Rush was also a persistent advocate for the education of women. He established and encouraged a variety of female schools. There were numerous years when he poured more of his time into raising money, setting up classes, and gathering books and staff for these colleges and schools than he devoted to his own medical practice. In addition, Rush was president of the Philadelphia Humane Society—which strove to save the lives of drowners, both accident victims and attempted suicides.

Benjamin Rush synthesized empiricism and faith in fascinating ways that influenced his philanthropy. He was a scientist whose first love was chemistry, the producer of 85 serious articles and books, a true evidence-seeking, open-minded observer. A person anxious at all times to “add to my stock of ideas upon all subjects,” he studied Laplanders, disease in China, and Persian diets. He looked into Hinduism and Orthodox Judaism. He urged his students, according to historian and fellow Revolutionary-era physician and congressman David Ramsay, “to think and judge for themselves, and would freely, and in a friendly manner, explain his principles, resolve their doubts, listen to their objections, and either yield to their force, or show their fallacy.”

Yet Rush rejected the extreme rationalism of the Enlightenment. He concluded that God was the primary cause of all things, and the ultimate source of benevolence in human behavior. He worshiped frequently and with great piety at numerous churches in the many neighborhoods his house calls took him to.

By the end of his life, both medicine and politics had disappointed Rush. Philadelphia’s horrific yellow-fever epidemics near the close of the eighteenth century killed up to 10 percent of the population in each outbreak. Rush was one of the few physicians to stay in the city during these panics, attending to more than 100 patients a day (even while suffering from yellow fever himself during the 1793 outbreak). Despite his heroic efforts to stanch suffering, Rush was attacked viciously for his ineffectiveness at saving lives, leading eventually to a boycott that cost him nearly all of the paying customers of his medical practice and estranged him from his home city.

Rush was also distressed by the terrible squabbling among the former colonies, particularly during what he called the “lost decade” after the Revolution and before ratification of the U.S. Constitution. This showed him that even the best-intended political ventures would always be hobbled by foolish, fearful, selfish human nature.

So, “strongly impressed with a sense of divine things” and “animated by a hope in God’s mercy,” as he put it, he fell back on the Gospel truths to guide him through his later adult life. It was his spiritual vision more than anything else that drove Benjamin Rush’s powerful benevolence, And in this way a medical doctor spread across America the noble virus of charitable profusion.

~ Karl Zinsmeister

Further reading:

• Alyn Brodsky, Benjamin Rush: Patriot and Physician (St. Martin’s Press, 2004)
• Amanda Moniz, From Empire to Humanity (Oxford Press, 2016)

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